This is not It!

In the words of the prophetic Chumbawumba, “I get knocked down, but I get up again…”

And again. And again. And again.

If there is one thing I do truly well, it’s disappointment. You would think that somewhere along the way I would have learned that expectations are premeditated disappointments. The way to avoid a helluva lot of disappointment is to stop expecting things to turn out my way.

Like, if you don’t expect to get roses on Valentine’s Day, then you’re not disappointed when you don’t. D’uh.

And if you don’t expect to get the promotion you really wanted, you won’t be disappointed when you don’t. So, why am I sitting here crying? Because I expected to get the promotion and I did not. Again. I’ve been turned down for this position twice in the last four years. I am pretty stubborn. Relentless. I don’t give up. I once ran the last five miles of a marathon without shoes because my shoes were killing my feet and I was not about to give up.

There are two ways to handle disappointment. The way I handled it before my last spectacularly awful major depression and the way I handle disappointment after my last spectacularly awful major depression. BD – before depression. AD – after depression. BD, I would have told myself that I am a total loser. I will never be good enough. I would have been pissed off at the bosses who chose someone else for the job and I would have been pissed at the person who got the job.

AD, I give myself some time on the mat before I get up. Today, after learning I did not get the job, I packed up my stuff and went home. I could have sat in the office, crying, explaining to everyone why I was upset but that would have upset me even more. So, I took care of myself. I packed up a bunch of stuff I was working on and went home. I had a good cry, talked to a friend on the phone and then worked from home. I get more done here anyway.

Truth is, I love what I do now. I would have loved getting the other job but the job I have now is pretty freakin’ cool. This is about my pride. Pride – one of the seven deadlies. This is about acceptance. This is about humility. Learning how to handle disappointment appropriately and take care of myself in these situations is the essence of good mental health.

What happened today will not take me down. There was a time – not too long ago – when it would have. I know now that it’s okay to stay down on the mat for awhile and catch my breath. When I get up I will be harder, faster, stronger and smarter than before. I will have a little more faith in my higher power – that if I let go of this disappointment, he will bring even better things into my life.

Then, I will get up again.

Loneliness

It is a cliche that we can feel lonely - even particularly lonely - in a crowd. Unfortunately it is one that is only too true and all too common at university. Here, surrounded by people of a similar age and, supposedly, with lots in common we can nevertheless feel wretchedly isolated and awkward. This is made worse by the sight of others who seem perfectly at ease, are rapidly making friends and are becoming embedded in groups from which you feel excluded or only tolerated on the margins.

Looked at from another angle, however, it is not surprising that loneliness at university is common especially among first year students. Coming to university is a major stage in 'leaving home'. It may indeed be the first time you are away not just from the supportive familiarity of home and family, but away also from friendships that may have been built up over years.

Leaving home and coming to university involves a number of changes: in lifestyle, work patterns, and degree of independence. The accumulated effects of these can make people feel uncertain of what to do or how to be. Social insecurities can then creep in, even in people who normally feel quite socially adept. So, for some, loneliness is a new and disconcerting experience, while for others it is more familiar, but may now be accompanied by disappointment that university has not brought a hoped for change.

If you are starting a new job at the University, you will be meeting new people and wanting to prove yourself in your new role. Academic and research work can often feel very isolated.

Loneliness is common at university for many reasons including:

• you are away from friends and family
• it may be the first time in years - maybe even since primary school - when you have had to 'start from scratch' making new friends
• you may be missing old friends and finding it hard to replace them - or perhaps even a bit reluctant to replace them with substitutes
• you may have high expectations of university as a place where you will make friends for life, and be disappointed in the people you initially meet
• you may have a long distance relationship and feel torn between social life here and elsewhere
• you may be anxious about work and feel in conflict about spending time on social activities.

You can feel lonely:

• when you are alone and have no choice in this
• when you do not feel part of a group or event
• when there is no one with whom to share your feelings and experiences
• when you feel disconnected and alienated from your surroundings
• when there is no-one to know how miserable and isolated you feel.

Loneliness can make you feel:

• unloved and unwanted
• socially inadequate
• convinced that there is something wrong with you
• self-conscious and ill at ease with others
• angry and critical of others.

These feelings, of course, can then result in lowered self-esteem; a (usually unfounded) conviction that people do not want you around; a reluctance to even attempt to make friends or take part in social activities; an inability to assert yourself and say 'no' to things you do not want to do and a consequential feeling of being exploited.

What you can do about loneliness

• Remember that loneliness is very common. Almost everyone feels it at some time. It is not a defect. It is something that can be changed. It is a sign that important needs are not being met. Changing the situation may involve finding and developing a circle of friends, but it may also mean finding ways of learning to enjoy your times alone; to use them more constructively and pleasurably.
• Do not wait for other people to visit you or speak to you. Try to talk to people you sit next to in class or at meals or in breaks at work. Say hello, or even just smile, at people you pass on the staircase or elsewhere in college or in your workplace.
• Try to put yourself in new situations where you will meet people with interests in common. Choose activities that you are genuinely interested in and enjoy - societies or sports or voluntary work. Do not, however, over-extend yourself, filling your time with too many things just to avoid being alone.
• Do not deprive yourself of things you would like to do just because you have nobody to do them with e.g. going to a concert or for a walk, or seeing a film.
• Try not to be critical of your efforts. Remind yourself that intimate friendships take time to develop. Do not disparage friendships in the belief that only romantic relationships will relieve your loneliness or give you confidence and social status.
• Build relationships by being a good friend to others.
• Respond to others and their interests (but do not feign an interest you do not feel).
• Some people are more at ease in groups and others in 'one to one' situations. Consider your own preferences and 'style'. Find others with similar outlooks and interests. Remember that, despite appearances, not everyone is interested in bars or sports.

Try talking to the people in college who are there to support students, such as your tutor or the chaplain or JCR welfare officer. If you continue to feel lonely and miserable, you might consider coming to talk to someone at the University Counselling Service. The service has on offer a variety of approaches that may help you combat the feelings that loneliness brings, such as those described below.

Group Counselling

Small group counselling can be particularly helpful in providing an opportunity for students to fully realise that other people suffer difficulties which may be similar to their own. They can compare notes, offer each other support, and learn, in a safe context, something of how other people see them. The prospect of joining a group can feel a bit intimidating at first but it can be an enormous morale booster to realise that you are not alone in your feelings; that you are not particularly weird or unacceptable; that people can respond to you with warmth and understanding; and that you have things to offer other people.

Individual Counselling

1. Talking to a counsellor one to one can also help you understand and accept yourself better. It can help shift patterns of thought, and expectations that you will be rejected, and help to promote a more open, relaxed way of interacting with people. It can help boost confidence and self-esteem.
2. Cognitive-behavioural techniques can also help, for example by devising strategies for combating social anxieties and for changing the negative thought patterns through which we undermine ourselves.

Self-esteem is an opinion not a fact

The way we view and feel about ourselves has a profound effect on how we live our lives. These opinions are shaped by experiences in the family, at school, from friendships and in wider society. Self-esteem involves our ability to think, to deal with life and to be happy.

The background

From infancy we look for encouragement and approval. Yet our culture does not readily give this. Parents can be tough taskmasters in seeking the best for their children, as many of you may know. Young people have a tendency to be intolerant of difference and often mock their peers who are clever or hard working. The educational system with its emphasis on league tables implicitly demands more and more and leaves less scope for valuing improvement. There is a constant bombardment of messages telling us we should be young, slim, beautiful, fashionably dressed, have a lover and money to spend. Personal acknowledgement of ability and pride in oneself can be regarded as being arrogant, boastful, or conceited.

Rejection or loss at any age is likely to undermine self-esteem. Events like parents separating, a boy or girlfriend being unfaithful, being ostracised by friends or picked on by peers, dealing with an unsuccessful application, having an accident, a burglary, or coping with a death are likely to provoke feelings of loss and threat. For some this is temporary, while for others the effects are long-lasting.

Conversely, success is a great ego booster, and academic achievement can be an obvious signal of success. However, the wealth of talent and competitive environment of Cambridge can easily lead to self-doubt and insecurity. There is a lot of pressure on students to do well for the sake of family, College, and the University. You may even feel that other people over-estimate your ability and this burden of expectation can lead to a sense of failure and impossibility.

However, what we feel about ourselves is not based solely on what we do. It usually involves our relationships with others and whether we feel worthwhile as people. We have a basic human need to be wanted, noticed, and included. We want to contribute, to be of value, and make a difference - in other words to matter.

Our self-esteem will continually fluctuate and is affected by events and encounters with other people. We are also constantly judging and evaluating ourselves, often in comparison with others. Observing ourselves in relation to other people can be a helpful source of learning and feedback. Yet all too often comparison slips into competition and others become a yardstick by which we evaluate ourselves as good or bad, competent or inadequate.

The reality is we are all different. Each of us has strengths and limitations which we need to learn about and learn to live with. There are aspects of our behaviour and appearance we may seek to change or develop, but a sense of self is also based on self-awareness and self-acceptance.

Suggestions for increasing self-esteem

Change is not easy. It means stepping into the unknown and taking a risk. Inevitably this means that some initiatives will work well while others don't work out as you hoped. You can help yourself by being realistic in your choices and seeing each success as a step in the right direction.

Remember that small changes add up. Call on other people to help you by being encouraging, taking an interest, giving feedback, and making suggestions.

Do things for pleasure, for fun

• Think about ways you enjoy yourself. Put effort into making life pleasurable and satisfying. Arrange to be in situations which are playful and make you laugh.
• Learn something new. Maybe something you have always wanted to try, even something you never thought you could do. If you are stuck for ideas look on notice boards and in local publications, observe or ask other people, think about what you have enjoyed in the past.

Look after yourself physically

• Eating regularly, thinking about the sort of food you eat, and making sure you try to get the amount of sleep you need.
• Exercise and toning muscles can give confidence and help you to feel good about your body. Pay attention to how you stand and walk. Think tall.
• Pay more attention to your appearance. Pamper yourself. Choose a new hairstyle or colour in clothing. Buy a magazine which gives advice on personal presentation.

Use rewards, but avoid punishments

• Reward yourself in other ways. What about giving yourself one day off from work a week? Buy yourself a little treat. Do something you particularly enjoy but don't often get round to.
• We do not like other people saying nasty things about us so why say them to yourself? Listen to how you treat yourself - the internal conversation. Low self-esteem makes it difficult to identify strong points but it does not mean you do not have them - only that they are unfamiliar to you.
• Avoid as much as possible situations and people that leave you feeling bad about yourself and spend more time concentrating on experiences which are likely to be successful and rewarding.

Cultivate good relationships - with yourself and others

• Can you bear to be ordinary? Are you continually expecting more of yourself than you do of others? If you accept the troubles, mistakes and variability of other people, how about being happy with "good enough" in relation to yourself?
• Involve others. Ask for support, feed-back, affection. Be prepared to say you don't know. Talk about yourself. Do not pretend or hide. Take care not to push other people away through being negative about yourself.
• Join in with others. Do not assume you are not important; other people have an effect on you and you affect them. Most people are interested in making new friends, and friendships can begin at any time in life. Say hello; do not wait for other people to come to you. Smile. Be nice to others, volunteer, be helpful, pay compliments.

Take responsibility

• It is no good waiting for others or circumstances to leave us feeling better about ourselves. So accept responsibility for your own actions: as we cannot make other people change, we need to make the changes ourselves.

Bereavement Therapy

Grief and Bereavement

Grief is a natural response to loss. The degree of attachment to that which has been lost will determine the level of grief experienced. Thus, we grieve deeply for those we love, including our pets. We find it difficult to readjust following divorce. When experiencing trauma that changes our lives and circumstances, we grieve the loss of our old life. Given the right skills we can allow this process of grief to move through us. Unskilled as we are in our culture we become stuck, unaware of how we are meant to experience the sadness, and depth of emotion welling up within us.

You may find yourself thinking you are going crazy, friends and relatives telling you how you should be, work asking you to get back to normal! This is not possible, grief changes us, we are forever changed by our experience, and it does not have to be negative. Finding our own inner resources and understanding our emotional requirements during this time can empower us to transform the grief experience into wisdom and understanding of ourselves and those we love. We can find peace in the joy of life and the nature of Being, once we embrace the depth of our emotion, and flow with the grieving process.

“Should you shield the canyons from the windstorms,
you would never see the beauty of their carvings.”
- Elisabeth Kubler-Ross, MD

Grief Therapy and Bereavement Therapy

Using rituals and ceremony can help us. Time does not exist for the griever. There is no time frame for grieving. However, if you are feeling deeply depressed for a long period of time after the death of a loved one (6 months on) seek help and medical advice. You may have clinical depression and need some short term intervention. There is a difference between grieving and depression. It is normal to have bouts of deep sadness, crying and feelings of intense loneliness following the loss of a loved one. You may not want to get out of bed or face the world. Often these feelings can kick in after every one else is expecting us to be OK. After the funeral when friends and family have gone back to their lives and you are left with your feelings and loneliness, is when help is most needed. Help can come from someone who has been through the experience, and truly understands the nature of grief and grieving. A good friend, someone who will listen and not give advice, someone to offer a soft place to fall. Someone who ‘gets it’, without you having to explain.

Pre- Bereavement Thoughts.

Pre- Bereavement occurs when you know there will be a loss, but it has not yet occurred. This is what happens when a loved one is dying, and both the patient and their loved ones have time to prepare. Pre-Bereavement is both the easiest and the hardest kind of loss to experience. It is marked by “stop and go” signals. With these losses, the handwriting is on the wall... but it doesn’t make coping with it easier.

Because you have time to prepare, you can begin to envision and rehearse your life without the person who is dying.  This gift of time offers the opportunity to resolve any regrets you may have with or about your loved one.  You can take this time to make amends with your loved one, and to tell him or her how you feel about them. Your loved one can do the same with you, and other family members.  You can let go of anger or guilt.  You also have the chance for delicate conversations about such sensitive topics as death, end of life wishes, as one transitions right into bereavement. You also have an opportunity to get information about your family.

One obvious drawback to pre-bereavement is witnessing your loved one’s struggle with death.  As the loved one’s condition worsens, you may grieve with each downturn.  You may experience feeling a sense of helplessness as your loved one fights for life.  You may feel as if you are living with a pit in your stomach that won’t go away as you await death’s arrival.  In addition, sometimes when people are facing death, their own fear, pain, or anger may make their personality seem to change from Dr. Jekyll to Mr. Hyde overnight or even from one moment to the next.  In my own case, when five-way by pass to my father's heart, he became angered and for a time was isolated from me.  This was devastating to me. Thank goodness, his behavior did not last until the end of her life, and he regained her normal personality.  But for some families, the ones we love continue to have behavioral changes as they face the end of life. This can be challenging, and healthcare professionals such as hospice workers or counselors may be able to help.

Perhaps the most difficult challenge with pre-bereavement is that it is difficult to tolerate living in a state of emergency for an extended period of time.  The mind can only tolerate so much angst.   When a loved one is dying, the “emergency” and angst period may seem to last forever.  You do not want your loved one’s death to come more quickly, yet your mind may not be able to handle any prolongation.  Your mind may blank out self-protectively.

But eventually, a reminder or a new episode with the loved one sets off the bereavement again.  Here, intense bereavement comes in waves alternating with times of numbness.  These “stop and go” signals allow you to shut down emotionally.  This insulates you before the next event occurs.  Then, your bereavement begins anew.  These flat periods can be looked at as natural, normal, and welcome respite from the agony of the loss.  They do not mean you are cold or uncaring.

Pre-Bereavement is normal.  It is an important part of coping with a loved one’s extended illness.  It prepares both you and your loved one for the end of life.  Unfortunately, it may also be an emotional roller coaster.  If you can expect that and understand that, you can help yourself cope with it.  Don’t feel guilty about anything you may be feeling.  Instead, make the best out of each moment you can spend with your loved one, and focus on the positives, such as forgiveness, settling affairs, and helping your loved one make plans for their passing.

Death and Dying Process (Alzheimer's)

Death and Dying

During the final stages of dementia due to Alzheimer's disease, an individual may lose his/her  ability to ambulate, verbally communicate, swallow, or may become totally incontinent and continue to lose weight despite nutritional supplements.  Usually people with Alzheimer's die of another problem---perhaps a stroke, or pneumonia due to aspiration. At this point, the caregiver must be aware that the only way a person can stay alive is by inserting a stomach tube that provides artificial nutritional sustenance. Caregivers may have different feelings about this intervention for religious or personal reasons.  At the end stage of Alzheimer's the use of invasive procedures such as a stomach tube, can keep the persons alive from months to years. This important decision must be made by the family member and can create an "ethical dilemma". Families, should in no way feel pressured by a medical professional to insert life sustaining interventions.
When family members are prepared with regard to the physical process of death and dying they are more able to accept death as an inevitable and peaceful process. The recent expansion of Hospice Services has done much to promote discussions about death and acceptance of withholding end-of-life medical interventions. Once a person is terminal, as determined by a physician who understands the disease process, a caregiver may decide to engage Hospice Services.  The physician must be willing to certify that a person will die within six months. If the person does not die within six months, they are not disqualified from the program.
Hospice Services are usually provided by a local Home Health Agency. Hospice services can be provided in the home, assisted living facility as well as a skilled nursing facility. When a family signs up for Hospice Benefits they agree to forgo extreme invasive procedures and agree to support procedures that alleviate pain for the person with dementia. This is known as "palliative care" or comfort measures. At the final stage of death, water and food are withheld as the individual no longer desires this. This is a part of the natural process of dying.  
Families can anticipate the final stages of death by the various physical stages a person may be going through.  Barbara Karne, a Hospice  R.N. developed a very comprehensive booklet entitled "Gone From My Sight: The Dying Experience" which delineates the various physical stages of death and dying. To obtain a booklet, contact her at the following address: Barbara Karnes, R.N., P.O. Box 335, Stillwell, Kansas, 60085, 1995.
In Karnes' booklet she describes what occurs , one-three months prior to death, one to two weeks before death, days or hours before death, and then the final minutes. This information has been extremely helpful to families and can be summarized as follows: 
One to three months prior to death 

• Withdrawal from world and people
• Decreased food intake
• Increased sleep
• Going inside self
• Less Communication

One to Two Weeks Prior to Death

• Disorientation
• Agitation
• Talking with Unseen
• Confusion
• Picking at Clothes
• Physical Changes

• Decreased blood pressure
• Pulse increase or decrease
• Color changes; pale, bluish
• Increased perspiration
• Respiration irregularities
• Congestion
• Sleeping but responding
• Complaints of body tired and heavy
• Not eating, taking little fluids
• Body temperature hot/cold

Days or Hours

• Intensification of 1-2 week signs
• Surge of energy
• Decrease in blood pressure
• Eyes glassy, tearing, half open
• Irregular breathing, stop/start
• Restlessness or no activity
• Purplish knees, feet, hands, blotchy
• Pulse weak and hard to fine
• Decreased urine output
• May wet or stool the bed

Minutes

• Fish out of water breathing
• Cannot be awakened

Advance Directives:

It is important that individuals be aware of their wishes and that  the wishes be formally documented in a legal document that is known as an "Advance Directive".  Each state has different instruments for these directives and the caregiver should contact the local medical facility to determine the appropriate document to be be used.  The Advance Directive delineates one's  wishes regarding medical treatment and appoints a surrogate decision-maker on a person's behalf.  Of course, the important aspect of the Advance Directive is to discuss end-of-life care before one becomes diagnosed with dementia or has an another debilitating illness. 

A Great Message

Most of the time, when someone sends a sympathy card it is read and then discarded. Most cards contain such generic messages that they cannot really help the person feel better. They cannot be used throughout the years to bring the person who has passed back into their life. However, our bereavement verses offer people the ability to do just that. They are a memorial and a celebration of the person who has passed, along with the universal truths about life and death that help with the grieving process.

When you use Messages of Sympathy to convey your sadness over someone's loss, you will give them or yourself a product that can be used throughout the years. Our product can be instantly downloaded, so people can start to benefit from it immediately. It can then be played on the computer or on a DVD player. Our bereavement messages can be shared, or they can be kept private by the recipient.

When you use Messages of Sympathy, you will:

• Show the recipient how much you care
• Allow the recipient to feel hope
• Give them a product that can apply to many situations, which will allow them to use it over and over again

Many companies use bereavement quotes that do not have a significant meaning. They are the words that people associate with grief, but they do not reach out to the deeper feelings that the grieving person is feeling. They have been overdone, as they are put into most cards and written on most flowers. However, we do not use those words. We use our own, so your loved one can truly feel cared for when they receive our product.